Carpal tunnel syndrome (CTS) is a collection of characteristic signs and symptoms and signs that occurs following compression of the median nerve within the carpal tunnel at the level of the wrist.
Usual symptoms include numbness, tingling, burning, and pain in the median nerve distribution. These symptoms may or may not be accompanied by changes in sensation and strength of the structures in the hand. Acute pain is rarely seen with CTS.
Numbness and tingling
- Most common complaints, patients say that their hands fall asleep or that things slip from their fingers without their noticing (loss of grip, dropping things
- Symptoms are usually intermittent and are associated with certain activities such as driving, reading the newspaper, crocheting, painting.
- Nighttime symptoms that wake the individual are more specific to CTS, especially if the patient relieves symptoms by shaking the hand/wrist. Bilateral CTS is common, although the dominant hand is usually affected more severely than the other hand.
- Complaints should be localized to the palmar aspect of the first to the fourth fingers and the distal palm—supplied by the median nerve. Numbness existing predominantly in the fifth finger or extending to the thenar eminence or dorsum of the hand should suggest other diagnoses. A surprising number of CTS patients are unable to localize their symptoms further.
Pain
- Aching sensation over the top aspect of the wrist. This pain can radiate towards the palm and fingers or, extend along the ventral forearm. See your pain management doctors for this type of pain.
Autonomic symptoms
- Patients report symptoms in the whole hand. Many patients with CTS also complain of a tight or swollen feeling in the hands and/or temperature changes (e.g., hands being cold/hot all the time).
- Many patients also report sensitivity to changes in temperature (particularly cold) and a difference in skin color. This is a type of nociceptive pain that is different from somatic pain.
Weakness/clumsiness as in loss of power in the hand (particularly for precision grips involving the thumb) and the loss of sensory feedback and pain is usually a more important cause of weakness and clumsiness than is loss of motor power.